Montana

Infectious
Medical Waste

Medical waste differs from hazardous waste. Hazardous waste is regulated by the US EPA (and related state rules) under the Resource Conservation and Recovery Act. Medical waste is not covered federal environmental laws or US EPA regulations (with the exception of a medical waste that also meets the definition of hazardous waste). Rather, medical waste is mostly controlled by state law and associated regulations. In addition to state environmental agency laws/rules, aspects of medical waste management are also controlled by the Occupational Safety & Health Administration (federal and/or state) and Department of Transportation (federal and state).

Each of our 50 states have developed rules and implemented regulations for medical waste. The state rules vary to some extent, including terminology. Depending on which state you live in, you may hear the terms regulated medical waste, biohazardous waste or infectious medical waste. In most cases, these terms all refer to the same thing: that portion of the medical waste stream that may be contaminated by blood, body fluids or other potentially infectious materials, thus posing a significant risk of transmitting infection.

Most states have regulations covering packaging, storage, and transportation of medical waste. Some states require health care facilities to register and/or obtain a permit. State rules may also cover the development of contingency plans, on-site treatment, training, waste tracking, recordkeeping, and reporting.

In most states, the environmental protection agency is primarily responsible for developing and enforcing regulations for medical waste management and disposal. Although in some states, the department of health may play an important role or even serve as the primary regulatory agency. Where both agencies are involved, typically the department of health is responsible for on-site management and the environmental agency is responsible for transportation and disposal.

OSHA, whether it is the U.S. Department of Labor Occupational Safety & Health Administration or an OSHA state program (24 states operate their own program), regulates several aspects of medical waste, including management of sharps, requirements for containers that hold or store medical waste, labeling of medical waste bags/containers, and employee training. These standards are designed to protect healthcare workers from the risk of exposure to bloodborne pathogens. However, they also help to systematically manage wastes, which benefit the public and environment.

Regulated medical waste is defined by the US Department of Transportation as a hazardous material. DOT rules mostly apply to transporters rather than healthcare facilities; although, knowledge of these rules is important because of the liability associated with shipping waste off-site.

Definition of Infectious Waste

An “infectious waste” means waste capable of producing
disease. Infectious waste includes but is not limited to:

Cultures and stocks of infectious agents and associated
biologicals,

Human pathological waste, including tissues, organs,
and body parts removed during surgery or an autopsy;

Free-flowing waste human blood and products of blood,
including serum, plasma, and other blood components and items soaked
or saturated with blood; and

Sharps that have been used in patient care, medical
research, or industrial laboratories.

Management of Infectious
Waste

The following rules apply to the storage, transportation
and treatment of infectious waste:

Segregation: Infectious waste must be separated
from ordinary waste at the point of origin and stored until the waste
is rendered noninfectious or transported off-site.

Packaging/containers. Infectious waste must
be stored in containers with biohazard warning labels. The following
rules apply:

Sharps must be contained for storage, transportation,
treatment, and subsequent disposal in leakproof, rigid, puncture-resistant
containers that must be taped closed or capped securely to prevent
loss of contents.

Infectious waste other than sharps must be contained
in moisture-proof disposable containers or bags of a strength sufficient
to prevent ripping, tearing, or bursting under normal conditions of
use. The bags must be securely tied to prevent leakage or expulsion
of solid or liquid wastes during storage, handling, and transportation.

Storage. To inhibit the spread of infectious
agents, infectious waste must be stored prior to treatment in a secured
area that prevents access by unauthorized personnel and must be clearly
marked or labeled as infectious.

Handling. Handling of infectious waste must
be done in a manner to prevent compaction or other mechanical manipulation
that might cause the release of infectious agents.

Treatment/disposal. Treatment and disposal
of infectious waste must be accomplished through the following methods:

Incineration with complete combustion that reduces
infectious waste to carbonized or mineralized ash.

Steam sterilization that renders infectious waste
noninfectious. Steam-sterilized waste must be labeled identifying
it as such with heat sensitive tape or bagged in marked autoclavable
bags.

Sterilization by standard chemical techniques or
by any scientifically proven techniques approved by state and federal
authorities. Chemically treated waste or waste otherwise treated
must be appropriately labeled.

Liquid or semisolid infectious waste may be discharged
into a sewer system that provides secondary treatment or into a primary
treatment sewage system if waste is first sterilized by chemical treatment.
A subsurface disposal system installed and operated in accordance with
state or local sanitary regulations is, for the purpose of this subsection
(b), a sewer system providing secondary treatment.

If infectious waste has been rendered noninfectious
by one of the methods listed, it is no longer biologically hazardous,
it may be mixed with and disposed of with ordinary waste in the following
manner:

Infectious waste may be transported by the generator,
a municipal solid waste service, or a regulated commercial hauler to
an offsite treatment facility if the waste is confined in a leakproof,
noncompacting, fully enclosed vehicle compartment.

Infectious waste that has been treated by one of
the methods in subsection (4) may be disposed of in a properly operated
and licensed landfill.

Training. An employee who handles or manages
infectious waste must receive training provided by the employer that
is adequate to ensure safe performance of duties.

OSHA Regulations

In addition to the state medical waste environmental
regulations there are some Occupational Safety and Health Administration
(OSHA) rules that apply to medical/infectious waste. Montana is one
of 26 states covered entirely by the federal OSHA program. This program
is operated by the Occupational Safety and Health Administration. OSHA
rules (Occupational Exposure to Bloodborne Pathogens Standards) impact
various aspects of medical/infectious waste, including management of
sharps, requirements for containers that hold or store medical/infectious
waste, labeling of medical/infectious waste bags/containers, and employee
training. These requirements can be found in the HERC section entitled OSHA Standards for Regulated Waste.